Manoj Dissertation

“A STUDY ON PATIENT SATISFACTION LEVEL AMONG THE
HEALTH INSURANCE POLICY HOLDERS IN A SELECTED

HOSPITAL.”
BY
MANOJ. S. NAGANSURE
Dissertation submitted to the
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,

KARNATAKA, BANGALORE.
In partial fulfilment of the requirements for the degree of
MASTERS IN HOSPITAL ADMINISTRATION
Under the guidance of
Mrs. JAYASREE RADHAKRISHNAN
ASSOCIATE PROFESSOR
ACHARYA INSTITUTE OF HEALTH SCIENCES
COLLEGE OF HOSPITAL ADMINISTRATION
BANGALORE
2011
i

DECLARATION BY THE CANDIDATE
I hereby declare that this dissertation entitled “A study on Patient

satisfaction level among the health insurance policy holders in a selected
hospital” is a bonafide and genuine research work carried out by me under
the guidance of Mrs. Jayasree Radhakrishnan, Associate Professor,
College of Hospital Administration.
Date: 1st July, 2011 Signature of the Candidate
Place: Bangalore MANOJ S NAGANSURE

ii

CERTIFICATE BY THE PROJECT SUPERVISOR
This is to certify that this dissertation entitled “A study on Patient

hospital” is a bonafide research work done by MANOJ S NAGANSURE
in partial fulfilment of the requirement for the Degree of Master of
Hospital Administration.
Date: 1st July, 2011 Mrs. Jayasree Radhakrishnan
Place: Bangalore Associate Professor
College of Hospital Administration
iii

ENDORSEMENT BY THE PRINCIPAL
This is to certify that the dissertation entitled “A study on Patient

hospital” is a bonafide research work done by MANOJ S NAGANSURE
under the guidance of Mrs. Jayasree Radhakrishnan, Associate Professor,
College of Hospital Administration.
Date: 1st July, 2011 [Seal & Signature of the Principal]
Place: Bangalore Dr. (Col) S.C Mohanty
Principal
College of Hospital Administration
Acharya Institute of Health Sciences
iv

COPY RIGHT
DECLARATION BY THE CANDIDATE
I hereby declare that the Rajiv Gandhi University of Health Sciences,

Karnataka shall have the rights to preserve, use and disseminate this
Dissertation in print or electronic format for academic/research purpose.
Date: 1st July, 2011 Signature of the Candidate
© RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA
v

ACKNOWLEDGEMENT
At the outset I thank the almighty God for his abundant blessing and
guidance right through the study. I Bow my head in profound gratitude
before him.
I express my warm and sincere thanks to my guide Mrs. Jayasree

Radhakrishnan, Associate Professor, College of Hospital Administration
for her immense co-operation and constant encouragement throughout the
endeavour.
I thank our Principal Dr. (Col) S.C Mohanty and my College “Acharya
Institute of Health Sciences” for their support and co-operation.
I would like to express my gratitude to the Hospital authority and the staff
especially TPAs and hospital staff also Policy holders who helped me out
to complete my study on time.
Heartfelt thanks to all my friends in and out of the department. Special

thanks to RAVI RANA for his help, support and also tolerating me during
the study.
Last but not the least, I wish my sincere love and gratitude to my beloved
parents and my sisters for providing faith, strength and confidence to sail
through the boat of success.
Date: 1st July, 2011 Signature of Candidate
vi

TABLE OF CONTENTS
CHAPTER TITLE PAGE

NO.
1 INTRODUCTION AND REVIEW OF 1-13
LITERATURE
2 INDUSTRY PROFILE 14-19
3 COMPANY PROFILE 20-27
4 RESEARCH OBJECTIVES AND 28-33
METHODOLOGY
5 DATA ANALYSIS 34-47
6 INTERPRETATION OF DATA 48-55
7 FINDINGS AND SUGGESTION 56-59
8 CONCLUSION AND FUTURE 60-62
DIRECTION
9 BIBLIOGRAPHY 63-66
10 APPENDIX 67-73
vii

LIST OF TABLES
TABLE TITLE OF THE TABLE PAGE

NO. NO.
5.1 Distribution of sample based on the Type of Policy. 36
5.2 Response of policyholders whether health insurance is 37

beneficial.
5.3 Response of policyholders regarding awareness about TPA 38

and insurance company.
5.4 Response of policyholders on awareness about policy terms 39

and conditions.
5.5 Response of policyholders regarding information as to which 40

diseases covered under health insurance.
5.6 Response of policyholders regarding knowledge about 41

cashless process and list of empanelled hospitals with TPA.
5.7 Response of policyholders regarding proper guidance of 42

filling pre-authorization form.
5.8 Response of policyholders on availing 24hours of helpline 43

from TPAs.
5.9 Response of policyholders regarding queries answered by 44

TPA customer care.
5.10 Response of policyholders regarding problems in 45

documentation submission.
5.11 Response of policyholders regarding satisfaction of cashless 46

service.
5.12 Response of policyholders regarding overall function of TPA. 47
viii

LIST OF FIGURES
FIGURE TITLE OF THE FIGURE PAGE

NO. NO.
5.1 Distribution of sample based on the Type of Policy. 36
5.2 Response of policyholders whether health insurance is 37

beneficial.
5.3 Response of policyholders regarding awareness about TPA 38

and insurance company.
5.4 Response of policyholders on awareness about policy terms 39

and conditions.
5.5 Response of policyholders regarding information as to which 40

diseases covered under health insurance.
5.6 Response of policyholders regarding knowledge about 41

cashless process and list of empanelled hospitals with TPA.
5.7 Response of policyholders regarding proper guidance of 42

filling pre-authorization form.
5.8 Response of policyholders on availing 24hours of helpline 43

from TPAs.
5.9 Response of policyholders regarding queries answered by 44

TPA customer care.
5.10 Response of policyholders regarding problems in 45

documentation submission.
5.11 Response of policyholders regarding satisfaction of cashless 46

service.
5.12 Response of policyholders regarding overall function of TPA. 47
ix

CHAPTER- 1
INTRODUCTION
&
REVIEW OF LITERATURE
1

INTRODUCTION
'Happiness lies, first of all, in health.'
Health insurance guarantees payments to a person in the event of sickness or
injury and works as protection scheme. Health insurance is protection, scheme+ to take
care of health of a person and works it works by buying a policy from a company or an
insurance agent. Depending on the premium paid the health insurance policy will pay
specified amounts for the medical expenses incurred to overcome the health problem.
Life is full of uncertainties. Risk lurks in every nook and corner of human life. In
short, life is unpredictable. We need to be prepared for such circumstances. Leading a
happy life, involves good planning and analysis for your personal health. Accidents do
happen and you need to be prepared for such situations. In times of high health cost, you
need to get covered for health risks.
To overcome uncertainties in human life and lead a life free from stress, insurance plays
an important role. A good insurance should cover Doctor visits, Lab tests, Hospital stays
and Diagnostic tests.
There are quite a few companies covering health risks with good Insurance
policies. Health Insurance in India is included under the category of General (Non-Life)
Insurance. There are currently 17 General Insurance/Non-Life Insurance companies in
India offering various Health Insurance Products and Services. We will talk only about a
2

few of them.
Sickness is unpredictable and expensive when it strikes, and in developing
countries few families have healthcare budgets to handle it. As a result, many resort to
ineffective treatment options including failing to follow the full prescription course, self-
medication with purchase of drugs from local pharmacies, using inappropriate traditional
medicines, or ignoring the illness in the hope that it will go away on its own. These
coping mechanisms often allow the disease to progress, causing additional complications
that increase the cost of treatment in the long run. Poor coping mechanisms hence lead to
lost productivity, increased absenteeism at work, and greater uncertainty and anxiety. As
an intervention against risk (health-related or otherwise), insurance is an increasingly
common component of poverty alleviation strategies. While it is widely accepted that
insurance can help the poor reduce their vulnerability and avoid falling into greater
poverty after a shock,1 the client perspective on insurance is less understood. Are clients
satisfied with the products and services offered? Does the insurance industry provide
good coverage at affordable rates, in a way that resonates with the policy holder?
Moreover, do the insured understand the policy?
This study aims to shed light on the client perspective on insurance vis-à-vis two
health insurance satisfactions. In addition, this research will serve as part of a larger
project to develop a protocol for measuring patient satisfaction with insurance-one that
can be employed in many different contexts. The lessons learned here will help inform
that agenda.
Customer is the ‘King’. ‘Quality and service is what customers wants. It is a
promise of a high standard for the product or service, made to the customer/patient, and
3

leads to consumer delight each time when the consumer chooses that particular
product/service, rather than customer satisfaction. Patient satisfaction must be the
primary goal of any organization
The Patient satisfaction surveys helps in extracting feedback from the customers
about the products, services of the company. This is important since ultimately the
customer determines services and products, as well as revenues.
Product and service quality, patient satisfaction and company profitability are
intimately connected. Because, higher levels of quality results in higher level of patient
satisfaction. Satisfaction about the attitude of service providers and it is important, as
services are expected to affect the treatment outcome. There is a need to include the
patient’s perspective in the evaluation of services provided. Patient satisfaction surveys
are valuable tools healthcare providers can use to identify areas that need improvement.
By extracting accurate, measurable data, patient satisfaction surveys can help assess the
level of satisfaction in health insurance from patients' perspectives.
4

REVIEW OF LITERATURE
Health Insurance:
Health Insurance protects against the cost of illness, mobilize funds for health
services, increases the efficiency of mobilization of funds and provision of health
services and achieve certain equity objectives.1

Features of Health Insurance:
1. In the traditional indemnity system, customers first incur expenditure on services
and later submit claim to insurance company for reimbursement.
2. Managed indemnity in which a Third Party Administrator (TPA) takes care of the
claim settlement of enrols and directly reimburse service provider.
3. Insurer pays service provider fixed amount, out of which provider will serve
health needs of enrolees for specific period.
4. Reimbursement can be fee for services, which would involve charging for each
individual service, such as patient bed days, drugs, investigations etc.2
Role of Insurer:
The insuring institution can play an active role or passive role. If it is mere funding
entity and is not directly involved in the provision of healthcare services, controlling of
cost becomes difficult. It develops mechanism of cost sharing to mitigate the negative
impacts and beneficiaries are paid an amount each time they use the services as
deductibles or co-payment. On the other hand, if the insurance company is a managed
care organization it can enforce cost discipline more rigorously.3
5

Surveys of patient satisfaction have usually been fielded for one or two purpose.
First, the data have been used as dependent variables to evaluate provider service and
facilities, on the assumption that patient satisfaction is an indicator of the structure,
process, and outcome of care. Second, satisfaction data have been used as independent
variable to predict consumer behaviour (e.g. use of services), on the assumption that
difference in satisfaction influence what people do.4
The biggest problem is that satisfaction is an attitude based on a comparison
between expectations and experience. You might express satisfaction, for example, with a
less than optimal experience if you start out with low expectation for that service. I
wonder if something like that may be happening with satisfaction questions pertaining to
the cost and quality of health care coverage.5
Whenever there is need for hospitalization the policy holder should obtain an
Authorization Letter from Third Party Administration (TPA). The authorization letter
will indicate the name of the insured/patient, the name of the hospital where treatment is
required, the nature of illness/disease for which treatment is required and the monetary
limit above which the insured/patient will have to pay. The policy holder will have to
submit the authorization letter along with the identity card to the admission counter in the
hospital. The hospital will then start the treatment.6
TPAs are basically agents with no risk and their own profitability at forefront.
How can there be standard rates fo0r all hospitals? Cost inputs of each hospital vary;
6

therefore price range will also vary. Most charitable and nursing homes operate with thin
margin.7
The Third Party Administrative will additionally offer a 24 hours toll free helpline
access to physicians, specialists, diagnostic centers and ambulance services.8
All the records of medical insurance policies of an insurer will be transferred to
the TPA once the insurance company has given the business to a TPA. The following
steps are involved from the issues of Authorization to the latter settling the claims.
The TPA issues an Authorization letter to the hospital for treatment, and will pay
for the treatment.
TPA will track the case of the insured at the hospital and at the point of discharge;
all the bills will be sent to TPA.
TPA makes payment to the hospital.
TPA sends all the documents necessary for the consideration of claim, along with
bill to the insurer.
Insurer reimburses the TPA.9
TPA services for the insurance companies:
Monitor claims
Control claim ratio
7

Speedy handling of claims
Provide information about trends in the healthcare sector
Timely and adequate reports
In short remove the burden of insurer’s shoulders.
TPA services for the Policyholders:
provide a 24 hours 7 days a week helpline
issue identity cards and guide book
Facilitate cashless access to a large number of hospitals
Provide accurate anytime anywhere information on hospital network, policy
status.
Answer queries relating to claims.
Settle claims as per policy terms and conditions
Customer grievances cell etc.10
Insurance companies say there have been numerous instances of overcharging by
hospitals and this exercise would reduce the possibility of being cheated by the hospital.11
TPAs and Health Insurance

TPAs are in nascent stage in India. Managed care assumes critical significances in
India as the private practice and hospitals are not regulated and face a number of
8

challenges. Considering the current trends most of the government- owned insurance
companies offering mediclaim insurance have started hiring TPAs. New entrance in
health insurance will also find the service of TPA important.12
Consumer satisfaction is a complex theoretical concept, but it is relatively easy to
measure in practice and can be a valuable tool for quality improvement. Consumers'
evaluations of occupational health services will become increasingly important due to
changes in the organisation of occupational health care. Occupational healthcare
providers are encouraged to measure the consumer satisfaction of their services.13
Clientele
The client groups can be divided into two broad groups: corporate and individual.
Often the entire administration of medical facility and benefits for employees are handled
and managed by TPAs who design and customize a policy to suit the needs according to
the nature of health risks the employees face. Most of TPAs operating in India focus on
corporate.14
Third party administrator (TPA) is a separate company, which acts as an
intermediary between the policyholders and the health insurance company. The role of
Third party administrator (TPA) can be best realized in the context of outsourcing the
processing of claims. Objective of introducing TPA is to promote customer care services.
Moreover, the Third party administrators (TPAs) have got tie ups with the reputed
hospitals and so we can enjoy cashless facilities from them during emergencies. Third
9

party administrators (TPAs) will be directly paying the hospital bills to the hospitals and
we can take out the patient from the hospital without even spending a penny from pocket.
This is surely one of the greatest advantages of Third party administrators (TPAs).
The advent of Third party administrators (TPAs) is expected to play an important
role in health insurance market in insuring standardization of charges and managing
cashless service in health insurance. Their presence is also aimed at higher efficiency and
improving penetration of health insurance in the country.15
Conservatives and some in the media think these voters are not serious about
change, but that misreads them, as we realize from our focus groups last week. They are
"satisfied" with their choice of doctors, that their employer is picking up most of the cost
and that they may have better insurance than others. But, they are not happy about having
traded off wages or gotten locked into a job because of health care or about the fate of a
child with a chronic ailment who may not be able to get insurance in the future. So, they
are nervous about change, but they want it.16
TPAs organize healthcare providers by establishing networks with hospitals,
general practioners, diagnostics centres, pharmacies, dental clinics, physiotherapy clinics,
etc. They sign a memorandum of understanding with insurance companies according to
which they inform policyholders about the network of healthcare delivery facilities and
various system and process for the settling claims. Policyholders are enrolled and
registered with TPAs to avail of these services and in the event of hospitalization, health
facilities are expected to inform the TPAs. The medical referee of TPA examines the
10

admissibility of the case and accordingly informs the healthcare facility to proceed with
the treatment.17
Third party administrators (TPAs) are essentially insurance intermediaries, which
undertake the entire administration of Health plans for insurance companies. Apart from
setting claims, Third party administrators (TPAs) also process business, offer customer
service and technical support.18
A TPA is a person or an organization that processes claims and may perform
other administrative services in accordance with a service contract – A firm which
provides administrative services for employers and other associations having group
insurance policies. The TPA in addition to being the liaison between the employer and
the insurer is also involved with certifying eligibility, preparing reports required by the
state processing claims. TPA’s are being used more with increase in employer self-
funded plans. TPAs are the business of processing medical claims.19
The health infrastructure in India is facing daunting challenge of meeting the
health goals and complexities emerging from the changing diseases pattern. The
proliferation of various healthcare technologies and the increase in the cost of care has
necessitated the exploration of health financing options to manage problems arising out
increasing healthcare costs. Health insurance is emerging fast as an important mechanism
to finance the healthcare needs of people.20
11

“As unemployment rates rise across the nation, more members are moving to
individual health plans from employer-sponsored plans,” said Jim Dougherty, executive
director of the healthcare group at J.D. Power and Associates. “By more effectively
managing the member experience for this growing segment of subscribers, health plans
could reap considerable financial benefits through increased retention and
recommendations, and prepare themselves for the anticipated healthcare reform measures
facing the industry, which are likely to drive additional enrollment among previously
uncovered individuals and small employers.”21
The industry is fear of suffering from an informal nexus among corporate houses,
corporate hospitals, TPAs and insurance companies in ensuring high claim ratio on
corporate insurance and low on individual insurance.22
Third Party Administrator (TPA) was introducing through the notification on
TPA –Health Service Regulations, 2001 by the IRDA. Their basic role is to function as
an intermediary between insurer and the insured and facilities the cash less service of
insurance. For this service they are paid a fixed percent of insurance premium as
commission.23
A Third Party Administrator is a business entity providing claim services on
behalf of an Insurance Carrier or a self-insured Employer. A Third Party Administrator
can be empowered to act for numerous insured entities.24
12

It is expected that with the introduction of TPA services, claim settlement process
would be simplified. IRDA has suggested that all claims should get settled in seven days.
In a case study done in Ahmadabad, it was observed that an insurance company takes on
an average 121 days to settle the claim.25
IRDA defines TPA as “an insurance intermediary licensed by the authority who,
either directly or indirectly, solicits or effects coverage of, underwrite, collect, charge
premium from an insured, or adjust or settle claims in connection with health insurance,
except as agent or broker or an insurer”.26
13

CHAPTER-2
INDUSTRY PROFILE

14

INDUSTRY PROFILE
Opportunities in Indian Health Sector provide extensive research and objective
analysis in India. With global revenues of an estimate $2.8 trillion, the healthcare is the
world’s largest industry. India’s high population makes it an important player in the
industry. Based on the insurance regulatory and development authority, the Indian
healthcare industry has the potential to show the same exponential growth that the
software and healthcare have shown in the past decade.
The PRIMARY ACTIVITY of the health care service centres are providing medical,
diagnostic and treatment services and also specialized accommodation services to in-
patients i.e., receiving individuals for medical reasons, providing them with medical care
on an on-going basis and offering diagnostic and treatment services.
The SECONDARY ACTIVITY of health care service centers is to provide a wide
variety of outpatient services. The various healthcare systems are:-
1) Traditional System:- Ayurveda, Siddha, Unani, Homeopathy and Yoga.
2) Modern System:- Allopathy.
The hospital is the allied sub sector of healthcare in India. These establishments have an
organized medical staff of physicians, nurses and other health professionals,
technologists and technicians. Healthcare service centers use specialized facilities and
equipment that form a significant and integral part of the production process. Various
15

service segments have been briefed along with growth drivers, critical success factors,
issues and challenges, and regulatory environment. Based on critical analysis of the
industry and views of the industry experts, the outlook is prepared.
GROWTH AND DEVELOPMENT OF THE INDUSTRY:
Healthcare industry in developing world is all set to grow exponentially and India
with its inherent qualities can become the global hub for healthcare services. It is being
touted as the next ‘big boom’ and the sector is expected to grow rapidly over the next
decade, to reach a level of Rs 3200 billion by 2012, largely spurred by an increased
corporate presence in the sector. The healthcare industry has two segments public
healthcare and private healthcare. Government healthcare infrastructure primarily caters
to serving the semi-urban. With the liberalization of the entry norms in the Indian
healthcare market has paved the way for private players. The Government of India is
offering several incentives to private organizations, including subsidized land and tax
benefits.
Economic reforms have also significantly raised the standard of living of a large
percentage of the population and the middle class segment is creating increased demand
for modern healthcare treatments. The combination of speciality healthcare services and
low cost advantage has led to a regular inflow of foreign patients. Corporate hospitals and
increase foreign investments have completely changed the face of Indian healthcare.
The national accreditation board for hospitals and healthcare providers (NABH)
set up the ministry of health under the quality council of India has finalized the guidelines
for accreditation of hospitals and other healthcare service providers
16

Health Insurance:
Health is wealth. Is that true? Of course, everyone wants to be healthy and this is
why we say health is the greatest wealth in the world. Apart from a balanced meal,
exercise, and so on, we need to have a health insurance to be in good health. Health
insurance is, basically, a promise by an insurance company or health plan to provide or
pay for health care services in exchange for payment of premiums.
Insurance policy has started since the 18th century. However, at that time, we had
Accident Insurance. The first accident insurance company was Franklin Health
Assurance Company of Massachusetts which was founded in the year 1850. This
insurance was mainly offered because at that time there were a lot of accidents and
injuries due to railroad and steamboat. Accident insurance agencies soon started sky
rocketing. It was indeed very successful. People had started realising how important
insurance is. In the year 1866, there were around sixty accident insurance companies
which were set up and ultimately, the number of insurance companies kept on
mushrooming.
Health insurance was proposed by Hugh the Elder Chamberlen in 1964. A health
insurance is a contract renewable either monthly or yearly between the insurance
company and the person. The Insurance Company will provide you with a quotation of
the insurance company. In the quotation, you will have the term of policy, that is how
long are you covered with the health insurance. The duration of the health insurance will
depend on the age of the insurance holder. If he is young, the insurance company may
17

advise him to take a long term health insurance and if the person is old, it might be the
contrary and get affordable health insurance. Apart from age, there are other factors like
health and income which are taken into consideration when quoting a health insurance.
Some insurance companies also do a medical checkup before provide a health insurance
policy. In the quote, you will also find how much you have to pay on a monthly or a
yearly basis. The health insurance quotation all consists of all the benefits which it
covers. Certain health insurance covers the insurer 100% but certain not. There are
several conditions which are applied. Different amount is paid in case of natural death,
accidental death, loss of one limb or two limbs or in case of permanent disability.
Since the past two decades, there has been a phenomenal surge in acceleration of
healthcare costs. This has compelled individuals to have a re-look on their actual monthly
expenditures, spending patterns and simultaneously allocate a proportion of their income
towards personal healthcare. This has resulted in individuals availing healthcare
insurance coverage not only for themselves but also for their family members including
their dependants. In short, healthcare insurance provides a cushion against medical
emergencies. The concept of insurance is closely concerned with security. Insurance acts
as a shield against risks and unforeseen circumstances. In general, by and large, Indians
are traditionally risk-averse rather than risk lovers by nature.
The share of public sector companies in health insurance premium was 76% and
that of private sector companies was 24% for the period 2005-2006. Health insurance
premium collected over 2005-2006 registered a growth of 35% over the previous year. In
2001 the IRDA introduced provisions for third party administrators (TPA’s) to support
the administration and management.
18

Some major health insurance companies in India include National Insurance
Company, New India Assurance, United India Insurance, ICICI Lombard, Tata AIG,
Royal Sundaram, Star Allied Health Insurance, Cholamandalam DBS, Bajaj Allianz
Apollo, AG Health Insurance Company among others.
19

CHAPTER-3
COMPANY PROFILE
20

COMPANY PROFILE
The selected hospital was started by an International Mission Board in January 15
1973. Hospital is located on Bangalore-Hyderabad national highway. The new Bangalore
international airport is just few kilometres away.
Hospital caters to the growing middle-income population in India, meeting their
demand for modern healthcare services at prices attractive to patients, insures and
employees. The company is constantly improving, upgrading, and adding to its existing
medical systems to meet customer demands, to enhance facility operations, and to
pioneer 21st century healthcare delivery in Asia.
¾ Governed by Christian Medical College, Vellore, since 1989
¾ Currently 325 beds
¾ Over 750 staff and students
¾ Multi-speciality health care facility
¾ 8 Post-Graduate residency programmes
¾ 175,000 out-patients, 13000 in-patients annually
¾ 3,800 surgeries and 2,700 deliveries annually
21

¾ Annual Operating Budget INR 363 million
VISION:
Healing and Wholeness in the spirit of Jesus Christ.
MISSION:
To provide quality holistic care to all people and train others to do the same,
sharing the love of Jesus Christ, drawing people to Him and growing together into a
nature community.
Services standards:
¾ Professionalism
¾ Accuracy
¾ Courtesy
¾ Timeliness
Management:
¾ Governed by Christian Medical College, Vellore
¾ Administrative Committee manages logically
¾ Director/Chief Executive Officer (CEO) is the chief functionary
¾ Functionally, all activities are classified into none Divisions: Medical, Nursing,
Nursing School, Allied Health, Pastoral Care, Community Health,
Administration, Finance, and Support services.
¾ Divisions are further classified as Departments
22

Training Programmes:
¾ DNB in surgery, Orthopedics, Pediatrics, Medicine, Obstetrics and Gynecology,
Family Medicine and Anesthesia
¾ Nursing Diploma level Training
¾ Allied Health Diploma programmes in Medical Records, Laboratory Technology,
Radiography Technology and OT Technology
¾ Training in Clinical Pastoral Education (CPE), Diploma in Clinical Pastoral
Counseling (DCPC) – Senate of Serampore, Diploma in Pastoral Healing
Ministry (DPHM)
Services:
¾ Special Private Rooms, Private Rooms and Birthing Rooms
¾ Semi-Private Rooms and Three General Wards
¾ Four Operations Theatres
¾ Adult ICU, CCU, HDU, NICU, PICU
¾ Cath – Lab
¾ State-of-the-art Laboratory, Blood Bank and CT Scan
¾ 12-bed round-the-clock Casualty
¾ Dialysis
¾ 24-hour Pharmacy
23

Specialities:
¾ Blood Bank ¾ Orthopaedics
¾ Cardiology ¾ Pathology and Microbiology
¾ Dental Implants ¾ Paediatrics
¾ Dentistry ¾ Pediatric Endocrinology
¾ Dermatology (Skin) ¾ Pediatric Orthopedic Surgery
¾ ENT ¾ Pediatric Orthopedics
¾ Family Medicine ¾ Pediatric Surgery
¾ Gastroenterology ¾ Plastic Surgery
¾ HIV /AIDS Clinic ¾ Psychiatry
¾ Infertility Clinic ¾ Pulmonology
¾ Internal Medicine ¾ Radiation Oncology
¾ Neurology ¾ Radiology
¾ Neurosurgery ¾ Rheumatology
¾ Obstetrics and Gynaecology ¾ Speech and Hearing Therapy
¾ Ophthalmology ( Eye) ¾ Sports Clinics Medicine
¾ Oral and Maxillofacial Surgeries ¾ General Surgery
¾ Orthodontics ¾ Vascular Surgery
24

Special Facilities:
¾ Laparoscopic Key-hole Surgery
¾ 24-hour Blood Bank
¾ 24-hour Casualty and Pharmacy
¾ ANC ( Ante-natal Care ) Packages
¾ Birthing Rooms and Painless labour
¾ Color Doppler Ultrasound Scan
¾ C T Scan
¾ Dialysis
¾ Diet Counselling
¾ EEG, ENMG
¾ Endoscopies / Interventional
¾ Hospice and Home Care
¾ Mammogram
¾ Pastoral Care
¾ Preventive Health Packages
¾ PUVA Therapy
¾ Sleep Lab and PFT (Pulmonary Function Test)
¾ Well-equipped Physiotherapy unit
¾ X-ray unit, II TV, C-Arm
25

Registration:
Monday to Friday : 7:30 AM to 2:30 PM
Saturday : 8:00 AM to 12:00 PM
Sunday Holiday : For Emergencies: Contact 24-hour Casualty
Evening clinic : 4:30 PM to 7:00 PM (Monday to Friday)
Consultation:
Monday to Friday : 8:15 AM to 2:30 PM
Saturday : 8:15 AM to 12:30 PM
Sunday Holiday : For Emergencies: Contact 24-hour Casualty
Evening clinic : 4:30 PM to 7:00 PM (Monday to Friday)
Corporate and Medical Insurance Patient Services:
Patients coming from companies who are tied up with this hospital for their staff
health care/ clients health care that are having medical insurances and various
government and semi-government schemes can contact the corporate patient services
department. This department facilities as one-stop for registration, eligibility
identification, cost analysis and other necessary information. This department channel
out-patients, admission, discharge process and documentation.
26

At present the following are major medical insurance clients / corporate clients:
¾ TTK Healthcare Services Pvt Ltd
¾ Arogya Bhagya yogna (ABY)
¾ Bajaj Allianz
¾ Bharat Electronic Limited (BEL)
¾ Bruhat Bangalore Mahanagara Palike (BBMP)
¾ Family Health Plan Ltd
¾ Genins India Ltd
¾ ICICI Lombard
¾ Medi-Assist India Pvt Ltd
¾ Paramount Healthcare Services
¾ United Healthcare
27

CHAPTER-4
RESEARCH OBJECTIVES
&
METHODOLOGY
28

RESEARCH OBJECTIVES AND METHODOLOGY
4.1 OBJECTIVES OF THE STUDY:
1. To understand the work flow between hospitals, Third party administrator (TPA),
and Insurance Company.
2. To assess the patient satisfaction level through patient survey.
3. To provide recommendations to improve the usefulness to the policy holders.
4.2 DEFINING THE SCOPE OF THE STUDY:
The study focuses on developing and understanding the patient satisfaction level
among health insurance policy holders and also aims to shed light on the on the patient
perspective on health insurance. The study will examine the implications for patient in
terms of product coverage, accessibility, timeliness, and product appropriateness. In
addition, this research will serve as part of a larger project to develop a protocol for
measuring patient satisfaction with health insurance one that can be employed in many
different contexts in the hospitals. This project is taken up with a clear vision of the
objective.
29

4.3 USEFULNESS OF THE STUDY:
• Helps to ensure better services to the policy holder.
• It is helpful to understand the cause of delayed claim by health care
providers.
• It helps to increase the level of satisfaction among policy holders.
4.4 LIMITATIONS OF THE STUDY:
1. The study is limited to only one hospital.
2. The study was restricted to hospital more than 100 beds.
3. The study was restricted to more than 5 years hospital.
4. The viability of the study is restricted to the information provided by the
policyholders, hospital staff and TPA’s.
4.5 METHODOLOGY OF RESEARCH:
Research methodology refers to the methods the researcher use in performing
research operation. Research methodology is a way to systematically solve the research
problem. This chapter explains the methodology adopted in this study for conducting
research.
4.6 STATEMENT OF THE PROBLEM:
“A study on Patient satisfaction level among the health insurance policy holders
in a selected hospital”
30

4.7 RESEARCH APPROACH:
Research approach adopted in the study was analytical on the basis of analysis of
data. It includes collection of information, opinions from patients through structured
questionnaire, interview schedules and observation.
4.7.1 SOURCE OF DATA:
Primary source:-
Primary data was collected by giving the questionnaire to the Policyholders,
insurance manager with the help of pre-structured questionnaire.
Secondary source:-
The secondary data was collected from periodicals, books, journals, research
studies, articles, related websites, etc.
4.7.2 CONTENT VALIDITY:
Content validity refers to the extent to which an instrument measures what is
supposed to measure. Validity of the tool was established by the opinion and
suggestions of experts from the fields of administration and statistics.
4.7.3 DATA COLLECTION PROCESS:
The required data and information was collected from primary and secondary
source. The data collected through direct observation, with the help of structured
questionnaire. The questionnaire was structured with the help of various literature
source as well as journals.
31

4.7.4 SETTING OF THE STUDY:
The study was conducted in a 202 bedded multi speciality hospital at Bangalore.
This esteemed institute is well known for its multitude of services. The hospital is
equipped with all modern technologies and provides excellent medical care using a cost
effective rational approach.
4.7.5 NATURE OF POPULATION:
The population included in this study were the policy holders, hospital staff, and
TPA staff, empanelled with selected hospital during the study period.
4.7.6 SAMPLE AND SAMPLING TECHNIQUE:
The sample is selected using a Purposive Sampling technique. The questionnaire
was given to 50 policy holders and 10 hospital staff, and TPA staff.
4.7.8 TOOLS AND TECHNIQUES:
The tool of data collection used in this study was developed in the light of
extensive review of literature and consultation and experts in the field. The data
collected with the help of direct observation and structured questionnaire. The
investigator personally visited the hospital and collected the data.
32

4.7.9 DURATION AND FOLLOW UP THE STUDY:
The study spread over a period of one year. First collected the related review of
literature, then investigator prepared questionnaire under the guidance of expert in
the field. After that collection of data in a selected hospital. Observation, finding,
recommendations, discussion, and conclusion were done at the end of the study.
33

CHAPTER-5
DATA ANALYSIS
34

DATS ANALYSIS
The questionnaire consisted of the following:
• Demographic data consisted of personal information of the respondents from
Policyholders relating to type of Policy.
The data collected with the help of questionnaire from the Policyholder and
Hospital and TPA staff was analyzed. The method was used to describe sample
characteristics in terms of percentage. Inferential statistical analysis were used for
analysis and interpretation of data tables showing the number of respondents and their
respective percentage and percentage bar diagrams were used for the interpretation of
the results. Inferential statistics was used to describe the demographic variable of the
type of policy.
35

TABLE-5.1:- Distribution of sample based on the Type of Policy.
Type of Policy No of Policyholders No. Of Policyholders

(Sample) (Percentage)
Self 21 42%
Corporate 29 58%
Total 50 100%
FIGURE-5.1:- Distribution of sample based on the Type of Policy.
42%
Self
Corporate
58%
The above table 5.1 and figure. 5.1 shows that 50(100%) respondents, 21(42%) had self
policy and 29(58%) had corporate policy.
Thus, it’s observed that self policy holders are less then corporate policy holders.
36

TA
ABLE-5.2::- Responsee of policyh
holders wheether health insurance is beneficcial.
Ressponse Typ
pe of Policyy
Self Self porate Corporate

Corp
(Sample) (Percentaage) (Sam
mple) (Peercentage)
Y
Yes 18 86% 2
24 83%
No 3 14% 5 17%
T
Total 21 100% 2
29 100%
FIIGURE-5.22:- Responsse of policyyholders wh

hether heallth insuran
nce is benefficial.
%
86% 83%
90%
80%
70%
60%
Response
50%
40% yes
30% 17% no
14%
20%
10%
0%
self cooprorrate
Type of P
Policy
Thhe above taable 5.2 annd figure 5.22 shows th

hat out of 21(100%)
2 of self policcy holders,
188(86%) saidd that healthh insurance is beneficiaal and 3(14%

%) said not beneficial.
Out of 29(100%) of corporate poolicy holdeers, 24(83%

%) said thatt health insurance is
beeneficial and 5(17%) saaid not beneeficial.
37

TA
ABLE-5.3::- Responsse of policcyholders regarding
r awarenesss about TP
PA and
in
nsurance coompany.
Response Ty
ype of Policcy
Self Self porate C

Corp Corporate
(Sample) (Percentage) (Sam
mple) (Percentage)
Yes 13 62% 2
20 69%
No 8 38% 9 31%
Total 21 100%
% 2
29 100%
FIIGURE-5.33:- Respon
nse of policyholders regarding awarenesss about TP
PA and
in
nsurance coompany.
69%
70% 62%
60%
50% 38%
Response
40% 31%
yes
30%
no
20%
10%
0%
self cooproraate
Type of Policy

hat out of 21(100%)
122(62%) saidd that they were awaree of difference betweeen TPA andd Insurance Company
annd 8(38%) said

s weren’tt aware.
Out of 29(1000%) of coorporate poolicy holderrs, 20(69%) said that they were aware of
diifference beetween TPA

A and Insuraance Compaany and 9(31%) said weeren’t aware.
38

TA
ABLE-5.4::- Responsse of policyyholders on
o awareneess about policy terrms and
coonditions.
Response Typ
pe of Policyy
Self Self Corporate Coorporate

((Sample) (Percenta mple) (Percentage)
age) (Sam
Yes 16 76% 17 59%
No 5 24% 122 41%
T
Total 21 100% 299 100%
nse of pollicyholderss on awarreness of p
policy term
ms and
coonditions.
76%
80%
70% 59%
60%
50%
Response
41%
40% yes
2
24%
30%
no
20%
10%
0%
self cooproraate
Type of Policy

hat out of 21(100%)
166(76%) saidd that they were awaree of policy terms and conditions whereas 5((24%) said
thhey weren’t aware.
Out of 29(100%) of corpporate policcy holders, 17(59%)

1 saiid that they were awaree of policy
teerms and connditions whhereas 12(411%) said theey weren’t aware.

a
39

TA
ABLE-5.5::- Responsse of poliicyholders regardingg informattion as to
o which
diiseases coveered underr health inssurance.
R
Response Ty
ype of Policcy
Self Self porate C

Corp Corporate
(Sample) (Percenttage) (Sam
mple) (P
Percentage)
Yes 14 67% 16 55%
No 7 33% 13 45%
Total 21 100%
% 2
29 100%
TA
ABLE-5.5::- Responsse of poliicyholders regardingg informattion as to
o which
diiseases coveered underr health inssurance.
67%
70%
55%
60%
45%
50%
Response
3
33%
40%
yes
30%
no
20%
10%
0%
self cooproraate
Type of Policy
Thhe above table

t 5.5 annd figure 5.5
5 shows that out of 21(100%) of policy
yholders,
144(67%) toldd they had been

b prioryy informed to
t which disease coverred under in
nsurance
w
whereas 7(333%) weren’tt informed.

1 tolld they had been priory
y informed
too which diseease coveredd under insuurance wherreas 13(45%

%) weren’t iinformed.
40

TA
ABLE-5.6::- Responsse of policcyholders regarding knowledgge about cashless
prrocess and list of emp

panelled hospitals with
h TPA.
Response Typ
pe of Policyy

age) (Sam
Yes 11 52% 19 66%
No 10 48% 10 34%
T
Total 21 100% 299 100%
nse of poliicyholders regardingg knowledgge about cashless
panelled hospitals with

prrocess and list of emp h TPA.
66%
70%
60% 52%
48%
50%
34%
Response
40%
yes
30%
no
20%
10%
0%
self cooproraate
Type of Policy
Thhe above table

t 5 shows that out of 21(100%) of policy
5.6 annd figure 5.6 yholders,
111(52%) toldd they hadd knowledgge about cashless

c proocess and list of emp
panelled
hoospitals wheereas 10(48%) weren’tt aware of itt.
Out of 29(1000%) of coorporate poolicy holderrs, 11(52%)) told they had knowlledge of
caashless proccess and listt of empanelled hospitaals whereas 10(48%) w

weren’t awarre of it.
41

TA
ABLE-5.7::- Responsee of policyh
holders reg
garding prroper guidaance of filliing pre-
au
uthorizatioon form.
Response Typ
pe of Policyy
Self Self porate

Corp C
Corporate
(S
Sample) (Percentaage) (Sam
mple) (Peercentage)
Y
Yes 16 76% 2
24 83%
N
No 5 24% 5 17%
Total 21 100% 2
29 100%
FIIGURE-5.77:- Responsse of policyyholders reegarding prroper guidaance of filling pre-
au
uthorizatioon form.
83%
90% 76%
80%
70%
60%
Response
50%
40% yes
2
24%
30% 17% no
20%
10%
0%
self cooproraate
Type of Policy
Thhe above table

166(76%) toldd they hadd proper guidance off filling pree-authorizattion form whereas
5((24%) wereen’t guided.

2 told they hadd proper guid
dance of
fillling pre-auuthorization form whereeas 5(17%) weren’t guuided.
42

TA
ABLE-5.8::- Responsse of policcyholders on
o availingg 24hours of helplin
ne from
TPAs.
Response Typ
pe of Policyy

age) (Sam
Yes 13 62% 19 66%
No 8 38% 10 34%
T
Total 21 100% 299 100%
nse of policyholders on availin
ng 24hours of helplin
ne from
TPAs.
66%
%
70% 62%
60%
50% 3
38%
34%
Response
40%
yes
30%
no
20%
10%
0%
self cooproraate
Type of Policy
Thhe above table

133(62%) toldd they weree able to avaail 24hours of helplinee from TPA
A’s whereass 8(38%)
w
weren’t able.
Out of 29(1000%) of coorporate policy holderrs, 19(66%)) told they were able to avail
244hours of heelpline from

m TPA’s whhereas 10(34
4%) weren’t able.
43

TA
ABLE-5.9::- Responsse of policcyholders regarding queries aanswered by
b TPA
cu
ustomer care.
Response pe of Policyy
Typ

age) (Sam
Yes 16 76% 20 69%
No 5 24% 9 31%
T
Total 21 100% 299 100%
nse of poliicyholders regarding queries aanswered by
b TPA
cu
ustomer care.
76%
80% 69%
70%
60%
50%
Response
40% 31%
yes
24%
30%
no
20%
10%
0%
self cooproraate
Type of Policy
Thhe above table

166(76%) toldd that querries were answered

a by
b TPA cuustomer carre whereas 5(24%)
w
weren’t answ
wered.
Out of 29(1000%) of corrporate policcy holders, 20(69%) toold that queeries were answered
a
byy TPA custoomer care whereas

w 9(31%) weren’’t answered.
44

TA
ABLE-5.100:- Respon
nse of policcyholders regarding problems in documeentation
su
ubmission.
Response Typ
pe of Policyy

(
mple) (Percentage)
Yes 8 38% 144 48%
No 13 62% 15 52%
T
Total 21 100% 29 100%
FIIGURE-5.110:- Response of poliicyholders regarding problems in documeentation
su
ubmission.
70% 6
62%
60% 52%
48%
50%
38%
Response
40%
yes
30%
no
20%
10%
0%
self cooproraate
Type of Policy
Thhe above taable 5.10 and

a figure 5.10
5 showss that out of
o 21(100%
%) of policy
yholders,
8((38%) told that they had facedd problems in docum

mentation suubmission whereas
133(62%) werren’t had it.
Out of 29(1100%) of corporate

c p
policy hold
ders, 14(48%
%) told thhat they haad faced
prroblems in documentat
d tion submisssion whereaas 15(52%) weren’t hadd it.
45

TA
ABLE-5.111:- Responsse of policyyholders regarding sattisfaction oof cashless service.
s
Response Typ
pe of Policyy

(
mple) (Percentage)
Yes 17 81% 25 86%
No 4 19% 4 14%
T
Total 21 100% 299 100%
FIIGURE-5.111:- Respoonse of policyholderrs regardiing satisfaaction of cashless
seervice.
86%
90% 81%
80%
70%
60%
Response
50%
40% yes
30% 19% no
14%
20%
10%
0%
self cooproraate
Type of policy
Thhe above taable 5.11 and

a figure 5.11
5 showss that out of
o 21(100%
%) of policy
yholders,
177(81%) toldd that they were

w satisfieed with the cashless seervice whereas 4(19%)) weren’t
saatisfied.

2 tolld that theyy were satisffied with
thhe cashless service

s wheereas 4(14%
%) weren’t saatisfied.
46

TABLE-5.12:- Response of policyholders regarding overall function of TPA.
Response Self Self Corporate Corporate

( Sample) (Percentage) ( Sample) (Percentage)
Excellent 5 24% 7 24%
Very good 10 48% 15 52%
Good 6 28% 7 24%
Bad 0 0% 0 0%
Very bad 0 0% 0 0%
Total 21 100% 29 100%
TABLE-5.12:- Response of policyholders regarding overall function of TPA.
60%
52%
50% 48%
40%
Response
30% 24% 28%

24% 24%
Self
20%
Corporate
10%
0% 0% 0% 0%
0%
Excellent Very good Good Bad Very bad
Type of Policy
The above table 5.12 and figure 5.12 shows that out of 21(100%) of policyholders,
5(24%) told that overall function of TPA was excellent, 10(48%) told it was very good
and 6(28%) told well.
Out of 29(100%) of corporate policy holders, 7(24%) told that overall function of TPA
was excellent, 15(52%) told it was very good and 7(24%) told well.
47

CHAPTER-6
INTERPRETATION
OF
DATA
48

DATA INTERPRETATION
Health insurance is emerging fast as important mechanism to finance the
healthcare needs of people. Further, the uncertainty of the disease accentuating the
needs for insurance system that works on the basic principle of pooling risks of
unexpected costs of person falling ill and needing hospitalization by charging premium
from a wider population base of same community.
With the advent of TPA’s this sector assumed a new dimension. They serve as a
vital link between insurance companies, policyholders and healthcare providers. The
core service of health insurance is to avoid paying up hefty deposits prior to admission,
to give greater relief to policy holders.
In the present study, attempt has been made to understand patient satisfaction
level among health insurance policy holders in a selected hospital.
The hospital where the study was conducted is the multi speciality hospital with
capacity of 202 beds. The hospital is committed in providing compassionate
confidential and prompt treatment to all policy holders that enter the portal. The hospital
is going to be certified by NABH for its continued improvement in quality healthcare
services. The hospital has separate department for insurance claims known as corporate
49

services department and it has tied of with 15 TPA’s. The department is provided with
the facilities like TPA help desk, insurance coordinators, fax, telephone, email etc to
ensure better service to the policy holders.
Indian Health Insurance is primarily classified into 2 categories:
• Cashless Hospitalization
• Medical Reimbursement
a) Cashless Hospitalization
Cashless hospitalization is a specialized service provided by an insurer wherein
an individual is not required to pay the hospitalization expenses at the time of discharge
from the concerned hospital. The settlement is done directly by the insurance company
(or insurer). However, prior approval is a must from the TPA (Third Party
Administrator) before availing the benefits under this option.
Cashless hospitalization can be of two types:-
• Planned hospitalization: This is a planned hospitalization wherein the insured is
aware of the hospitalization in advance. This duration period may vary from case to
case. Examples include: FTND (Full Term Normal Delivery), Chemotherapy treatment
for carcinoma (cancer), for cataract surgery, tonsillectomy (removal of tonsils).
• Emergency hospitalization: It is a sudden hospitalization that may be either an
50

emergency or due to unforeseen circumstances. In short, hospitalization is not
anticipated in advance. Examples include RTA (Road Traffic Accident), Myocardial
infarction (heart attack), Acute Appendicitis.
b) Medical Reimbursement
Re-imbursement means to repay or to compensate. Thus, Medical Re-
imbursement means to repay the products/services availed during hospitalization and
more importantly after the completion of the treatment.
Under this procedure, the insured has to bear the entire expenses incurred during
hospitalization. After getting discharged from hospital, the insured/policy holder can
claim medical reimbursement. For availing benefits under this option, the insured has to
approach the concerned TPA under which he/she is covered, fill the requisite form and
satisfy all the requirements as mentioned. This includes submission of TPA card, policy
paper, discharge summary, prescriptions, diagnostic laboratory reports, OPD treatment
details etc. A sum is granted as reimbursement for treatment expenses.
In India, public funded healthcare is available only to a miniscule section of BPL
(Below Poverty Line) groups, low-income groups and to government employees. The
Indian Government has formulated Employee State Insurance Scheme (ESIS) that
focuses on the public healthcare policy for low-income groups. The government
employees can avail Central Government Health Scheme (CGHS) that offers medical
treatment at a subsidized cost.
With the opening up of insurance sector for private participation, numerous
51

players have entered the healthcare segment, but in spite of the entry of private sector,
penetration of insurance coverage in India is abysmally low. Recently a legislature has
been passed in the Indian Parliament allowing 49% of FDI in insurance industry.
DEMOGRAPHIC VARIABLE
Basically the researcher has framed the questionnaire for policy holders to study
the response of them. For this the research has firstly asked for policy holder’s details
like Name, Gender, Age, and what Type of Policy they have. In total, the researcher has
framed questions with specified choices for every question, these questions cover the
objectives, to analyse the responses and find the challenges faced by the policy holder.
In the first study it is viewed that 42% have self medi-claim policy whereas 58%
have corporate medi-claim policy. (Table No. 5.1)
Interpretation according to response
During the study it was found that 86% of the self policy holder and 83% of the
corporate policy holder agreed that health insurance is beneficial while 14% of the self
policy holder and 17% of corporate policy holders think that health insurance is not
beneficial.( Table No.5.2 ).
Awareness of difference among TPA and insurance company
From the current study it was found that 62% of self policy holders and 69% of
the corporate policy holders agreed that they are aware of difference between TPA and
52

insurance company, while 38% of self policy holders and 31% of the corporate policy
holders said that they are not aware of it. (Table No.5.3)
Awareness of policy terms and conditions regarding the diseases which covered
under health insurance.
During the study it was found that 76% of self policy holders and 59% (83%) of
the corporate policy holders said that they are aware regarding the policy terms and
conditions regarding the diseases which covered under the policy terms and conditions,
whereas 24% of self policy holders and 41% (17%) of the corporate policy holders said
that they are not familiar with the policy terms and condition. (Table No.5.4 and 5.5)
Knowledge about cashless process and list of empanelled hospitals with TPA
The response shows that out of 21(100%) of self policy holders, 11(52%) told
that they had knowledge about cashless hospitalization and network hospitals whereas
10(48%) weren’t aware of it. Out of 29(100%) corporate policy holders, 19(66%) told
that they had knowledge about cashless hospitalization and network hospitals whereas
10(34%) weren’t aware of it. Thus it’s observed that 30(60%) were aware of cashless
process and empanelled hospitals. (Table No. 5.6)
Guidance at the time of filling pre-authorization form:-
The table shows that out of 21(100%) of self policy holders, 16(76%) told that
they got proper guidance in filling pre-authorization form, whereas 5(24%) weren’t had
53

it. Out of 29(100%) corporate policy holders, 24(83%) told that they got proper
guidance in filling pre-authorization form, whereas 5(17%) weren’t had it.
It shows that 40(80%) out of 50(100%) told that they got proper guidance in
filling pre-authorization form by the respective department. (Table No. 5.7)
24 hours helpline:-
From the current study it was found that 62% of self policy holder agreed that
there is availability of 24 hours helpline while 38% are not agreed, but in case of
corporate policy holder 66% are strongly agreed while 34% said that there is no such
helpline for 24 hours from TPAs
From the above statement it is clear that there should be 24 hours helpline for any
assistance which helps to increase the satisfaction level among policy holders. (Table
No.5.8)
Queries answered by TPA customer care:-
The study highlighted that 76% of self policyholder stated that the TPA
customer care answered the queries properly and 24% said that they didn’t respond
properly, while 67% of corporate policyholder respond that the TPA customer care are
helpful for answering queries, but 33% are not agreed regarding TPA customer care
response. (Table No 5.9)
Documentation submission:-
From the study it was found that 38% of self policy holder and 48% of corporate
policy holder stated that there is a problem in regarding the submission of documents,
54

but 62% of self and 52% of corporate policyholder responded that there is no as such
problem in document submission. (Table No. 5.10).
Cashless service:-
The response shows that 81% of the self policyholder and 86% of the corporate
policyholder stated that they are happy with the cashless service provided by insurance
company, but 19% of self and 14% of corporate policyholder thinks that the cashless
service is not good. (Table No. 5.11)
Grade:-
The study highlighted that 24% of self and corporate policyholder rated
excellent regarding the overall function of TPA, 48% of self and 52% of corporate
policyholder rated very good, but 28% of self and 24% of corporate policyholder rated
average regarding the functions performed by TPA. (Table No. 5.12).
55

CHAPTER-7
FINDING
&
SUGGESTIONS
56

FINDINGS AND SUGGESTIONS
7.1 FINDINGS:
The study named as “A study on Patient satisfaction level among the health
insurance policy holders in a selected hospital” is undertaken with the main objective to
understand the work flow between hospital, third party administrator and insurance
company also to assess the patient satisfaction through patient survey and provide
recommendations to improve the usefulness to the policy holders.
In this study, the data is collected by interviewing observing and by
administering the questionnaire to the selected sample in a selected hospital. Tables and
graphs are used for the analysis and interpretation of the data.
1. From the current study most of the people buy life insurance as just a tax benefit
tool or as a life cover while only a few of the respondent take it as a saving
option. The reason for this is lack of knowledge of insurance benefits among the
people
2. Few of the Policyholder responds that they are not aware of the difference
between TPA and insurance company.
57

3. According to the study most of the corporate policyholder not aware of various
terms, condition and exclusion clauses like which disease is covered under
insurance policy.
4. Majority of the policyholder have problem like
Delayed claim intimation.
Claim processing by the corporate staff
Time taken from the approval from the TPA
Delayed billings and discharge process
5. Most of the respondents are satisfied by the services offered by there
Insurance company while some says that they are not satisfied by the
services.
7.2 SUGGESTIONS:
9 Most of the respondents want more Transparency from the side of the
Company.
9 Client satisfaction should be assessed on a regular and ongoing basis,
rather than relying on one-time, cross-sectional surveys. For example,
client satisfaction questions should be incorporated into monitoring calls
and included in six-month reassessment interviews.
9 The TPAs should ensure proper approvals as early as possible.
9 Hospital should be ready with all necessary documents of the policyholder
in advance so that the discharge process time can be reduced.
58

9 Every TPA should send at least one of their executives to the hospital for
quick process of the claim and also to know what kind of difficulties a
patient is facing from the hospital.
9 Co-ordination between hospital and TPA should be improved.
59

CHAPTER-8
CONCLUSION
&
FUTURE DIRECTION FOR
THE SYUDY
60

CONCLUSION AND FUTURE DIRECTION FOR THE STUDY
8.1 CONCLUSION:
In the diverse country like India, health insurance needs differential approach.
Global experience with variety of approaches will work. Health insurance for India
needs to be contextualized to suite Indian conditions, health insurance not end-all
solutions, but is step in the right direction. Health insurance should not be seen as a
complete solution in achieving the goal of quality health care for all
However, the complexity of health insurance industry has been much talked
about but less understood, especially in Indian scenario. With the advent of TPAs this
sector assumed a new dimension; they serve as a vital link between insurance
companies, policy holders and health care providers
Policyholders, with a few exceptions, were very satisfied with the quality of
medical treatment and with the customer care they received at the Hospital. They
particularly appreciated having a dedicated Pre-payment Cashier to facilitate their
claims processing. Even though all policyholders are provided with an overview of the
claims process at the time of entry into the scheme, many remain dependent on the
guidance of the hospital health workers.
Majority policy holders had rated that cashless service was good but corporate
services department of hospital was unsatisfied with the services offered by the TPAs.
The response of hospital staff in transferring of information is good. Majority of policy
61

holders said that pre authorization and claim processing by the hospital is good.
However, the role of existing TPAs is not satisfactory and which requires improvement
to increase the patient satisfaction level among policy holders.
Some of the policy holders had problems like delayed claim intimation and
claim processing by the corporate staff, delayed approvals and short approvals from
TPAs, delayed billing and discharge process which requires improvement.
So, hospitals and TPAs should work as a team to ensure better efficiency among
policy holders to give them satisfaction.
8.2 FUTURE DIRECTION FOR THE STUDY:
Study can be done on a large sample in a wider manner
Compartive study can be done between two or more hospitals.
62

CHAPTER-9
BIBLIOGRAPHY
63

BIBLIOGRAPHY
1.
Mills, A. (2000): Health Insurance: Implications for the demand and supply of
health services. Presentation at two-day conference on ‘Health insurance in
India’. Indian institute of Management March 18-19, 2000.

2.
Kutzin, J and Barnum, H (1992): How Health Insurance Affects Delivery of
Health Care in Developing Countries. Working paper, Population and Human
Resource Department, The World Bank. Washington, D C.
3. Rothschild, M.; Stiglitz, J. (1976): Equilibrium in Competitive Insurance
Markets: An Essay of the Economics of Imperfect information Quarterly Journal
of Economics 40 [4].
4. Abdellah, F.G. and Levine, E. Developing a measure of patient and personnel
satisfaction with nursing care. Nursing Research 5: 100-108, 1957.
5. http://www.pollster.com/blogs/more_on_satisfaction_with_heal.php?nr=1
Mark Blumenthal | June 25, 2009
6. Dr. Symphony D. Cashless hospitalization and Health Insurance Awareness
among General Public and Patients. AIHA; Batch XI; 2006, Pp 83, 84.
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follow suit” –Express Healthcare Management, 2005 August 1-15; Pp 3.
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and practice”’ Economic and Political Weekly, Vol-xxx1x, No-28, July-
10,2004.
64

10. “Gyankosh”, Training Manual, Version-3.0, TTK Healthcare Services Private
Limited, Pp-5.
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2,7.
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Mark Blumenthal | June 25, 2009
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21. http://www.jdpower.com/healthcare/articles/2009-Health-Insurance-Plan-
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22. Gupta I.; Roy A., Trivedi M. (2004). Third Party Administrators – Theory and
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66

CHAPTER-10
APPENDIX
67

APPENDIX
Annexure –I:
Questionnaire for policyholders
Dear Sir/Madam,
I ( Manoj S Nagansure) would like to conduct “A study on Patient Satisfaction

level among the health insurance policy holders in a selected Hospital” ‘as a part of
my postgraduate certificate course in hospital administration under Rajiv Gandhi
University of Health Science.
I would like to have your frank opinion. The matters will be kept confidential
and if you wish to remain anonymous you need not fill in your name and designation.
Please tick to questions which you think is most appropriate.
1. Name :
2. Gender : Male ( ) Female ( )
3. Age :
4. Occupation :
5. Department : Medical ( ) Surgical ( )
6. Type of Policy : Self policy ( ) Corporate policy ( )
68

Questionnaire for Policyholder
Q.1) Do you think health insurance is beneficial?
A) Yes B) No
Q.2) Are you aware of difference between TPA and insurance company?
A) Yes B) No
Q.3) Are you aware of policy terms and conditions?
A) Yes B) No
Q.4) Have you been priory informed as to which diseases is covered under insurance?
A) Yes B) No
Q.5) Do you have knowledge about cashless process and list of empanelled hospitals
with your TPA?
A) Yes B) No
Q.6) Are you getting proper guidance at the time of filling the pre-authorization form by
respective department?
A) Yes B) No
Q.7) Are you able to avail 24hrs helpline from TPA’s?
A) Yes B) No
Q.8) Are your queries answered by TPA customer care?
A) Yes B) No
69

Q.9) Are there any problems in documentation submission?
A) Yes B) No
Q.10) Did the representative respond quickly and thoroughly when requested for more
information?
A) Very satisfactory B) Somehow satisfactory C) Satisfactory
D) Unsatisfactory
Q.11) Do you have problems with hospital’s TPA customer care service?
A) Not answering calls B) No proper guidelines
C) Not able to handle queries D) No 24hrs helpline
Q.12) Are there any reasons for claim denials?
A) Yes B) No
Q.13) Are you happy with the cashless service?
A) Yes B) No
Q.14) What are the reasons for delay in reimbursement?
Q.15) How you rate overall function of TPA?
A) Excellent B) Very good C) Good D) Bad
E) Very bad
70

ANNEXURE- 2
Dear Sir/Madam,
I ( Manoj S Nagansure) would like to conduct ‘A study on Patient Satisfaction

level among the health insurance policy holders in a selected Hospital ‘as a part of
my postgraduate certificate course in hospital administration under Rajiv Gandhi
University of Health Science.
I would like to have your frank opinion. The matters will be kept confidential
and if you wish to remain anonymous you need not fill in your name and designation.
Please answer to questions which you think is most appropriate.
Demo graphic profile of the employee.
1. Name :
2. Age :
3. Gender :
4. Education :
5. Designation :
6. Date of joining :
71

Questionnaire for Hospital staff
Q.1) With how many TPAs you are dealing?
Q.2) How do you correspond with TPAs?
A) Fax B) Telephone
C) Mail D) Online
Q.3) Do you have written instructions regarding non-claimable consumables given to
the patients?
A) Yes B) No
Q.4) Within how many days TPAs clear the amount?
A) Less than 7 days
B) 7 to 15 days
C) 15 to 30 days
D) More than 30 days
Q.5) Do you conduct a meeting with TPA administrative staff?
A) Yes B) No
Q.6) Are patients aware of the different between TPAs and direct insurance?
A) Yes B) No
72

Q.7) Are there any problems associated with the claim process and approvals?
A) Yes B) No
If yes, specify___________________________________________________
Q.8) Are there any problems during discharge of patients?
A) Yes B) No
If yes, specify___________________________________________________
73

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“A STUDY ON PATIENT SATISFACTION LEVEL AMONG THE

HEALTH INSURANCE POLICY HOLDERS IN A SELECTED

Dissertation submitted to the

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,

In partial fulfilment of the requirements for the degree of

MASTERS IN HOSPITAL ADMINISTRATION

Under the guidance of

Mrs. JAYASREE RADHAKRISHNAN

ACHARYA INSTITUTE OF HEALTH SCIENCES

COLLEGE OF HOSPITAL ADMINISTRATION

I hereby declare that this dissertation entitled “A study on Patient

Date: 1st July, 2011 Signature of the Candidate

Place: Bangalore MANOJ S NAGANSURE

This is to certify that this dissertation entitled “A study on Patient

Date: 1st July, 2011 Mrs. Jayasree Radhakrishnan

Place: Bangalore Associate Professor

College of Hospital Administration

This is to certify that the dissertation entitled “A study on Patient

Date: 1st July, 2011 [Seal & Signature of the Principal]

Place: Bangalore Dr. (Col) S.C Mohanty

College of Hospital Administration

Acharya Institute of Health Sciences

DECLARATION BY THE CANDIDATE

I hereby declare that the Rajiv Gandhi University of Health Sciences,

Date: 1st July, 2011 Signature of the Candidate

Place: Bangalore MANOJ S NAGANSURE

© RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA

I express my warm and sincere thanks to my guide Mrs. Jayasree

Heartfelt thanks to all my friends in and out of the department. Special

Date: 1st July, 2011 Signature of Candidate

Place: Bangalore MANOJ S NAGANSURE

CHAPTER TITLE PAGE

2 INDUSTRY PROFILE 14-19

3 COMPANY PROFILE 20-27

4 RESEARCH OBJECTIVES AND 28-33

5 DATA ANALYSIS 34-47

6 INTERPRETATION OF DATA 48-55

7 FINDINGS AND SUGGESTION 56-59

8 CONCLUSION AND FUTURE 60-62

TABLE TITLE OF THE TABLE PAGE

5.1 Distribution of sample based on the Type of Policy. 36

5.2 Response of policyholders whether health insurance is 37

5.3 Response of policyholders regarding awareness about TPA 38

5.4 Response of policyholders on awareness about policy terms 39

5.5 Response of policyholders regarding information as to which 40

5.6 Response of policyholders regarding knowledge about 41

5.7 Response of policyholders regarding proper guidance of 42

5.8 Response of policyholders on availing 24hours of helpline 43

5.9 Response of policyholders regarding queries answered by 44

5.10 Response of policyholders regarding problems in 45

5.11 Response of policyholders regarding satisfaction of cashless 46

5.12 Response of policyholders regarding overall function of TPA. 47

FIGURE TITLE OF THE FIGURE PAGE

5.1 Distribution of sample based on the Type of Policy. 36

5.2 Response of policyholders whether health insurance is 37

5.3 Response of policyholders regarding awareness about TPA 38

5.4 Response of policyholders on awareness about policy terms 39

5.5 Response of policyholders regarding information as to which 40

5.6 Response of policyholders regarding knowledge about 41

5.7 Response of policyholders regarding proper guidance of 42

5.8 Response of policyholders on availing 24hours of helpline 43

5.9 Response of policyholders regarding queries answered by 44

5.10 Response of policyholders regarding problems in 45

5.11 Response of policyholders regarding satisfaction of cashless 46

TPA makes payment to the hospital.

Insurer reimburses the TPA.9

Control claim ratio

Provide information about trends in the healthcare sector

Timely and adequate reports

In short remove the burden of insurer’s shoulders.

provide a 24 hours 7 days a week helpline

issue identity cards and guide book

Facilitate cashless access to a large number of hospitals

Provide accurate anytime anywhere information on hospital network, policy

Answer queries relating to claims.

Settle claims as per policy terms and conditions

Customer grievances cell etc.10